11D2098996 CLIA NUMBER - KROGER PHARMACY #653

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Laboratory Demographics

CLIA Number: 11D2098996

Facility Name: KROGER PHARMACY #653

Facility Address:
8465 HOLCOMB BRIDGE RD
JOHNS CREEK, GA
ZIP 30022
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Facility Phone Number: 770 552-4705

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1467794768

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	11D2098996
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #653
Street	8465 HOLCOMB BRIDGE RD
City	JOHNS CREEK
State	GA
ZIP	30022
Phone	770 552-4705
CertificateType	4
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024